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OBJECTIVES: To explore the risks and rates of readmission and their predictors 14 days, one year, and five years after discharge for the psychiatric population in Taiwan. METHODS: This was a prospective study based on claims from 44,237 first-time hospitalized psychiatric patients discharged in 2000, who were followed for up to five years after discharge. The cumulative incidence and incidence density of readmission were calculated for various follow-up periods after discharge, and Cox proportional hazard models were generated to identify the significant predictors for psychiatric readmission. RESULTS: The less than 14-day, one-year, and five-year cumulative incidences were estimated at 6.1%, 22.3%, and 37.8%, respectively. The corresponding figures for incidence density were 4.58, 1.04, and 0.69 per 1,000 person-days, respectively. Certain factors were significantly associated with increased risk of readmission irrespective of the length of follow-up, including male gender, length of hospital stay >15 days, economic poverty, a leading discharge diagnosis of schizophrenia/affective disorders, and residence in less-urbanized regions. Compared to children/adolescents, young adults (20-39 years) were significantly associated with increased risks of

Healthy physicians are critical to the quality of care for patients. There is a common trend in Chinese societies seeking for medical treatments from Chinese medicine physicians. However, there are limited studies that investigated the health status for the Chinese medicine physicians. In this report, we used National Health Insurance Research database of Taiwan between 1998 and 2002 to compare the morbidities between Chinese medicine physicians and general population. The number of Chinese medicine physicians in this study is 6,143 (5,036 males with the mean age of 40.47 years and 1,107 females with the mean age of 36.24 years), and the number of the referent subjects is 24,576, randomly selected from the database matching by sex and age. We found that the Chinese medicine physicians have lower all-causes morbidity (86% vs. 95%, p < 0.001), except that female Chinese medicine physicians had significantly higher rates of complications of pregnancy, childbirth, and puerperium than female population. Such an exception might reflect a consequence of maternal age effect. The odds ratio between all causes and two comparison groups was 0.36 (95% CI: 0.33, 0.40), indicating that the Chinese medicine physicians have much lower disease risk. Higher education, better socioeconomic status, and good knowledge in medicine (possible self-treatment) may explain the observed differences. Among the Chinese medicine physicians, the morbidity rate of male subjects is lower than the female subjects (85.9% vs. 91.4%, p < 0.001). This study will provide the helpful information in guiding future investigations about health hazards to the practice of Chinese medicine.

Objectives: This study aimed to determine whether a history of depressive disorders is associated with use and costs of prenatal care among pregnant women in Taiwan. Methods: Participants were mothers with singleton births between 2004 and 2006 (N=23,290), some of whom (N= 614) had received care for depression in the year before conception but not during pregnancy. Results: The mean number of prenatal care visits was 8.50 and associated costs were $NT 51,187 for pregnant women with a history of depressive disorders and 9.17 visits and $NT 27,998, respectively, for those without such a history. After adjustment for age, monthly income, medical conditions, and obstetric complications, mothers with a history of depression were significantly less likely to receive prenatal care (relative risk=.94, 95% confidence interval=.92–.97, p

Metabolic syndrome (MS) is most important because of its association with subsequent development of cardiovascular diseases. However, few studies about the prevalence of MS among hospital employees had been published.The aims of our study were to examine the prevalence of MS and associated factors. The up-to-date health examination data of 1,400 hospital employees of a medical center in North Taiwan were included, and MS was defined according to the criteria that were promulgated by the National Department of Health. The overall prevalence of MS was 10.3% (21.8% males, 7.0% females). Associated factors included male gender, aging, low education, administrative employees, abnormal hemoglobin concentration, and abnormal liver function indexes. According to our study, the prevalence of MS in hospital employees was lower than the general population, and the findings could be a reference to make more efficient health-promotion programs to lower the prevalence of MS in hospital employees.

Full-duplex radio-over-fiber (ROF) transport system employing broadband amplified spontaneous emission (ASE) light source and nonlinear distortions suppression scheme is proposed and demonstrated. Data rate of 10GHz/70Mbps signal is externally modulated and transmitted long-haul fiber link.

A full-duplex radio-over-fiber (ROF) transport system based on direct-detection scheme is proposed and experimentally demonstrated. In this approach, the RF power degradation introduced by fiber dispersion can be cancelled since the optical carrier and one of the sidebands are eliminated before detecting. A data stream of 70 Mbps transmitted over an 80-km single-mode fiber (SMF) transmission both for down/up-link with good bit error rate (BER) performance was achieved.

A directly modulated fiber-to-the-home (FTTH)/radio-over-fiber (ROF) transport system based on −1 side mode injection-locked and optoelectronic feedback techniques is proposed and demonstrated. Low BER values and clear eye diagrams were achieved in our proposed systems.

Blastocystis hominis is probably the most common protozoan found in the human gut worldwide. In Taiwan, the prevalence of B. hominis infection is yet to be determined but is expected to be relatively higher among foreign workers. No data is available on the prevalence of B. hominis infection in long-term care facilities in Taiwan. This study included 713 subjects (552 residents and 161 care workers) from ten long-term care facilities in Taiwan who completed stool microscopic examinations with Merthiolate-iodine-formalin stain technique. The prevalence rate of blastocystosis was the highest among foreign and domestic care workers followed by residents (12.2%, 4.6%, and 2.7%, respectively). Older age (p = 0.04) and lower educational level (p = 0.008) were significantly associated with blastocystosis among care workers. Among residents, B. hominis infection was negatively associated with prolonged use of antibiotics within 3 months prior to examination (p = 0.05) and positively associated with tracheostomy in-place (p = 0.028). In conclusion, B. hominis infection was the most prevalent intestinal parasitic infection among both care workers and residents of long-term care facilities in Taiwan. Use of antibiotics was negatively associated with B. hominis infection among residents. Additionally, appropriate preventive measures should be implemented to older care workers with lesser educational attainment in order to reduce the risk of blastocystosis infection.

The purpose of this study was to investigate the effect of yoga exercise on the health-related physical fitness of school-age children with asthma. The study employed a quasi-experimental research design in which 31 voluntary children (exercise group 16; control group15) aged 7 to 12 years were purposively sampled from one public elementary school in Taipei County. The yoga exercise program was practiced by the exercise group three times per week for a consecutive 7 week period. Each 60-minute yoga session included 10 minutes of warm-up and breathing exercises, 40 minutes of yoga postures, and 10 minutes of cool down exercises. Fitness scores were assessed at pre-exercise (baseline) and at the seventh and ninth week after intervention completion. A total of 30 subjects (exercise group 16; control group 14) completed follow-up. Results included: 1. Compared with children in the general population, the study subjects (n = 30) all fell below the 50th percentile in all five physical fitness items of interest. There was no significant difference in scores between the two groups at baseline (i.e., pre-exercise) for all five fitness items. 2. Research found a positive association between exercise habit after school and muscular strength and endurance among asthmatic children. 3. Compared to the control group, the exercise group showed favorable outcomes in terms of flexibility and muscular endurance. Such favorable outcomes remained evident even after adjusting for age, duration of disease and steroid use, values for which were unequally distributed between the two groups at baseline. 4. There was a tendency for all item-specific fitness scores to increase over time in the exercise group. The GEE analysis showed that yoga exercise indeed improved BMI, flexibility, and muscular endurance. After 2 weeks of self-practice at home, yoga exercise continued to improve BMI, flexibility, muscular strength, and cardiopulmonary fitness.

Airway sensitization requires the expression of prostanoid DP receptor in mice. Recent studies reported that polymorphisms in the gene encoding prostanoid DP receptor (PTGDR) were associated with asthma in White people and Black people, but this association could not be replicated among Latinos and Koreans. This study investigated the association between asthma-related traits and six single nucleotide polymorphisms (SNPs) of PTGDR in Chinese children, consisted of 308 asthmatics and 368 non-allergic controls. Plasma total and aeroallergen-specific immunoglobulin E were measured by immunoassays. PTGDR SNPs were determined by multiplex SNaPshot genotyping. All polymorphic markers followed Hardy-Weinberg equilibrium except G1044A in the controls (p = 0.021). The linkage disequilibrium (LD) scores for these SNPs were moderate to high, and in particular, T-549C and C-441T were in strong LD. Significant interethnic variations in PTGDR alleles and haplotypes (up to 41%) were found in our subjects when compared with White people or Latinos. Asthma diagnosis, atopy and aeroallergen sensitization did not differ among children with different PTGDR genotypes (p > 0.15 for all). Linear regression showed weakly significant associations between T-197C and G1044A of PTGDR and spirometric variables. PTGDR haplotypes were not associated with asthma and atopy phenotypes (p > 0.09 for all). Our results do not support PTGDR to be a major candidate gene for asthma traits in Chinese children.

Objective to examine the effectiveness of using foot reflexology to improve sleep quality in postpartum women. Design and setting randomised controlled trial, conducted at two postpartum centres in northern Taiwan. Participants 65 postpartum women reporting poor quality of sleep were recruited from July 2007 to December 2007. Interventions participants were assigned randomly to either an intervention or a control group. Participants in both groups received the same care except for reflexology therapy. The intervention group received a single 30-minute foot reflexology session at the same time each evening for five consecutive days. Sessions were administered by a certified nurse reflexologist. Measures and findings the outcome measure was the Pittsburgh sleep quality index (PSQI), and this was performed at baseline and post test. Mean PQSI scores for both groups declined over time between baseline and post test. Using a generalised estimation equation to control several confounding variables, the changes in mean PSQI were found to be significantly lower in the intervention group ( β =−2.24, standard error=0.38, p Conclusion an intervention involving foot reflexology in the postnatal period significantly improved the quality of sleep. Implications for practice midwives should evaluate maternal sleep quality and design early intervention programmes to improve quality of sleep in order to increase maternal biopsychosocial well-being. Midwives interested in complementary therapies should be encouraged to obtain training in reflexology and to apply it in clinical settings if it is allowed.

Studies on the physicians' health have paid less attention on the Chinese medicine than on the western medicine professionals. Like western medicine professionals, Chinese medicine physicians' health condition is critical to the quality of care and patients' safety. They also cared a large number of patients in many Asia societies. However, no data have been reported regarding the health problems associated with Chinese medicine physicians. The aim of this study was to examine the mortality patterns of a cohort consisting of 6109 male physicians of Chinese medicine who were followed from 1991 through 2003 in Taiwan. The analyses of female subjects were not included due to small sample size. We calculated the overall and cause-specific standardized mortality ratios (SMRs) and life expectancy of the study cohort using the death rates of some 11 millions of Taiwanese male population as reference. We found out that physicians of Chinese medicine experienced significantly lower death rate of mortality from all causes (SMR = 0.63, 95% > CI: 0.57, 0.69), from malignant neoplasms (SMR = 0.69, 95% CI: 0.57, 0.82) and from cerebrovascular disease (SMR = 0.53, 95% CI: 0.38, 0.72). Additionally, they have longer life expectancy (ranged from 3 years to approximately 15 years). Our study is crucial to evaluate potential health risks associated with Chinese medicine physicians. Although this study did not reveal elevated death rate among Chinese medicine physicians, researchers and policy makers should not overlook other heath problems that Chinese medicine physicians might have experienced.

A large number of hospitalized patients have an indwelling urinary tract catheter (IUC) placed at some time during their hospital stay and may suffer from catheter-associated urinary tract infections, the leading cause of nosocomial infections. Here we investigated the prevalence of uropathogens associated with catheter-associated urinary tract infections and assessed the resistances of these pathogens to commonly prescribed antibiotics. In total, 2,997 urine samples were examined at a regional hospital in Taipei, Taiwan in 2004: 1,948 (65%) samples from hospitalized patients and 1,049 (35%) samples from outpatients. Patients with IUCs accounted for 1,381 samples (46%). Stratified analyses were used to calculate the age- and gender-adjusted odds ratio (OR) of antimicrobial resistance associated with the use of IUCs. Compared to the urine specimens of the patients without IUCs, those isolated from catheterized patients had a lower prevalence rate of Escherichia (E.) coli (23.4% vs 36.8%) and higher rates of resistant strains including Pseudomonas species (16.4% vs 8.6%) and rare gram-negative bacilli (5.8% vs 4.5%). Additionally, IUCs significantly increased the antimicrobial resistance of E. coli (OR 2.41-3.07), other species of Enterobacteriaceae (OR 1.57-2.38), and rare gram-negative bacilli (OR 2.41-5.21) to nearly all antibiotics tested, such as trimethoprim/sulfamethoxazole. Thus, IUCs increased the prevalence of urinary tract infections caused by some highly resistant pathogens. Moreover, IUCs were associated with the increased risk of concurrent resistance of Enterobacteriaceae. Clinicians are advised to exercise better management of urinary catheter in order to further reduce and control catheter-associated urinary tract infections in hospitals.

The health of physicians is vital to the quality of care. Since Duffy and Litin (1964) found in 1964 an elevated risk of psychiatric disorders for physicians, the health among physicians has frequently raised attention, including not only psychological (Stavem, Hofoss, and Aasland 2003) but also physical (Sundquist and Johansson 1999; Stavem et al. 2001) health problems. For a long time, there has been mounting recognition of the fact that practicing medicine can seriously impact a physician's health (Sutherland and Cooper 1993; Caplan 1994; Silvester, Allen, and Withey 1994; Fish and Steinert 1995; Spurgeon, Barwell, and Maxwell 1995). In addition, physicians' heavy workloads might jeopardize the quality of care. It has been reported that higher risks of medical errors (Landrigan et al. 2004), adverse events, and attentional failures (Barger et al. 2006) were observed among interns with frequent extended-duration shifts. Moreover, it is not uncommon for physicians to be reluctant to seek health care from their colleagues through the usual mechanisms. Consequently, physicians may tend to work through illnesses and inappropriately care for themselves, resulting in late presentation with serious illnesses (McKevitt et al. 1997; Clarke, O'Sullivan, and Maguire 1998; Thompson et al. 2001). Since the launch of the National Health Insurance (NHI) program in 1994, the health services industry in Taiwan has changed dramatically. Universal health insurance removed barriers to health care for those newly insured, enabling them more equal access to health care (Cheng and Chiang 1997; Lu and Hsiao 2003). By the end of 2004, more than 98 percent of the Taiwanese people were covered by the insurance program (Division of Health Statistics 2003). Because of the increased demand for health care, the health professionals have encountered heavy workload strains and greater psychosocial demands (Lin, Chang, and Tsai 2004). Taiwanese physicians may experience higher workloads than physicians of Western nations. The number of physicians per 1,000 people in Taiwan was 2.0 in 2003 (Division of Health Statistics 2004), much less than the figures of most nations of the Organization for Economic Cooperation and Development (OECD). Except for Korea, Mexico, and Turkey, which have had fewer than 2 physicians per 1,000 people, the other 27 OECD nations have 2.1 (Japan and Canada) to 4.4 (Greece) physicians (OECD Health Data 2005). Moreover, the provision of universal health care coverage has increased the health care demand (Lu and Hsiao 2003). For example, the number of outpatient visit per person increased from 7.89 in 1992 to 11.46 in 2003 (Department of Health 2003). The annual number of outpatient visits per physician in Taiwan increased to 8,807 in 2003, from only 6,621 in 1992 (Division of Health Statistics 2004), suggesting an increasing heavy workload for physicians in Taiwan. Despite acknowledging the heavy workload among physicians in Taiwan, there are limited studies concerning their health status. Two recent surveys investigated the quality of life of physicians in Taiwan (Lin, Chang, and Tsai 2004; Lee et al. 2005). Based on Karasek's job demand-control model (Karasek et al. 1998), Lin, Chang, and Tsai (2004) reported that approximately 10 percent of the physicians practicing at a medical center in central Taiwan have high-strain jobs. This high-strain group reported a significantly lower quality of life, especially on the psychological scale, compared with the low-strain group. In another study, Lee et al. (2005) reported an inverse relationship between the level of job stress and quality of life among physicians at primary health care centers across the nation. In the present study, we further used the national insurance claim data to examine the risks and causes of hospitalization among physicians in Taiwan.

MixColumns/InvMixColumns dominates both the logic resource and the critical delay in advanced encryption standard (AES) hardware implementation with direct mapping S-boxes. The proposed decomposition method optimizes the area and the delay of integrated MixColumns/InvMixColumns circuit. Theoretically, the proposed short-path circuit reduces the area up to 42% with the same 5 XOR gates delay (Y.-K. Lai et al, 2004) in critical path. When synthesized in a TSMC 0.18 mum CMOS technology, the proposed short-path circuit has the top performance measured in AT and AT2.

Using Taiwan's National Health Insurance claim data, we evaluated the age-, sex-, and urbanization-specific incidence density and relative risks of hip fracture in the diabetic population.Diabetic patients (n = 500,868) and an age- and sex-matched control group (n = 500,248) were linked to inpatient claims (1997-2002) to identify hospitalizations for nontransport accident hip fracture. The person-year approach with Poisson assumption and Kaplan-Meier analysis were used to estimate the incidence and the cumulative event rates. We also assessed the age-, sex-, and urbanization-specific relative risks of hip fracture in relation to diabetes with the Cox proportional hazard regression model.The overall incidences of hip fracture for diabetic men and women, respectively, were 3.01 and 6.75/1,000 person-years, which were higher than those for control men and women. There were significant interactions of diabetes and age and diabetes and urbanization statuses. Hazard ratios (HRs) of diabetic patients aged 35-44 years (men 2.45 [95% CI 1.65-3.64]; women 3.19 [1.39-7.33]) were higher than those of diabetic patients aged 55-64 years (men 1.90; women 2.81), but in diabetic men aged74 years and diabetic women aged84 years, the HRs were compared with null statistically (HRs 0.98 and 0.91, respectively). Diabetic patients living in rural areas tended to have higher HRs of hip fracture.In Taiwan, diabetes increased the risk of hip fracture in both sexes in all age-groups except in diabetic men aged74 years and diabetic women aged84 years. Higher HRs of hip fracture were disproportionately observed in younger diabetic patients and in those living in rural areas.

Objective To investigate whether birth weight and paternal education may have independent and interactive effects on the learning achievement of adolescents. Study design We linked birth weights, gestational ages (term or preterm) and paternal education of a 4-year birth cohort to the Basic Competence Test (BCT) scores in Mandarin, mathematics and science for junior high school students age 15 to 16 years. The study groups comprised infants with term low birth weight (TLBW; n = 33 507), preterm normal birth weight (PNBW; n =19 905), and preterm low birth weight (PLBW; n = 25 840), as well as randomly selected term infants with normal birth weight (TNBW; n = 83 756). Paternal education levels were categorized. Results Compared with the TNBW adolescents, the TLBW adolescents consistently showed larger deficits in mean scores for Mandarin (β = −2.36), mathematics (β = −2.89), and science (β = −2.11). The corresponding significant deficit scores for the PLBW adolescents were −1.93, −2.80, and −1.92. The deficit scores were very small for the PNBW adolescents. Paternal education was inversely associated with scores of all 3 groups. Lower paternal education level tended to worsen the negative impact of low birth weight on BCT scores. Conclusions Both lower birth weight and lower paternal education exert an independent and interactive effect on adolescent learning achievement.

We carried out a population-based case-control study to identify people in Taiwan who are at increased risk of unintentional mortality from carbon monoxide (CO) poisoning (ICD-9 CM: 986 or E868). The study included all 439 deaths from unintentional CO poisoning registered in Taiwan's National Mortality Registry during 1997-2003, whereas 878 control subjects were randomly selected, with a control/case ratio of 2, from all deceased individuals from other causes during the same period. The annual mortality rate of CO poisoning significantly increased in Taiwan over the 7-yr period from 1.6 to 3.5 per 10(6) person-years. Thirty-six percent (n = 160) of the deaths occurred at home, and 21% (n = 93) were registered as in-hospital mortalities. A multivariate logistic regression analysis indicated that married people had a significantly reduced mortality odds ratio (MOR) of 0.50 (95% CI = 0.30-0.82) compared to single individuals. Additionally, residents of northern Taiwan (which is relatively urban) had a notably higher MOR of CO poisoning (MOR = 3.44, 95% CI = 1.40-8.44) than people residing in eastern Taiwan (which is relatively rural). Moreover, the MOR peaked in cold periods. A daily maximum temperature of18.4 degrees C was associated with a 2.15-fold increase in the MOR compared to a daily maximum temperature ofor = 27.1 degrees C. This study demonstrates an alarming increase in the unintentional death rate from CO poisoning in Taiwan between 1997 and 2003. Certain demographic and geographic characteristics were significant predictors for CO poisoning, suggesting a need for preventive strategies targeting these high-risk populations. Precautions should also be taken during periods of low temperatures.

Family caregivers in East Asian countries are known to have a strong sense of filial piety and a traditional caregiving ideology. They are generally presumed to be protected from psychological distress arising from caregiving. However, there is scant information regarding the impact of caregiving on Chinese/Taiwanese families. The purpose of this study was aimed at identifying those family caregivers of Taiwanese terminally ill cancer patients who are at risk of experiencing depressive distress from the following three categories of predisposing factors: 1) contextual factors; 2) stressors; and 3) appraisal of the caregiving situation. Of the 170 Taiwanese family caregivers of terminally ill cancer patients that participated in this survey, 129 (75.9%) were at an extraordinarily high risk of being distressed because of depressive symptoms (CES-D > 15). Results indicated that family caregivers were vulnerable to clinically depressive distress if they were the patient's spouse (adjusted odds ratio (AOR): 2.89; 95% confidence interval (CI): 1.19—7.01), or evaluated caregiving as imposing a greater negative impact on their own health (AOR: 1.27; 95% CI: 1.09—1.47). In contrast, if family caregivers felt very confident in their knowledge of how to take care of the patient at home (AOR: 0.35; 95% CI: 0.15—0.81), or were sufficiently aware of the patient's thoughts and feelings about disease experiences and symptoms (AOR: 0.47; 95% CI: 0.25—0.88), they were less likely to suffer from depressive distress. These finding have significant clinical implications when they are put into the context of Confucian cultures which place great emphasis on filial piety and familism. Interventions and policy should be developed to target spousal caregivers to enhance their confidence in caregiving and understanding of the patient's disease experiences. This will reduce the negative caregiving impact on the caregiver's health, which in turn may prevent the development of depressive distress among family caregivers. Palliative Medicine 2007; 21: 249—257

WEI, JUNG-NAN, HUNG-YUAN LI, FUNG-CHANG SUNG, CHAU-CHING LIN, CHUAN-CHI CHIANG, CHUNG-YI LI, AND LEE-MING CHUANG. Birth weight correlates differently with cardiovascular risk factors in youth. Obesity. 2007;15:1609–1616. Objective: Childhood obesity has become prevalent, resulting in a greater risk of hypertension, diabetes, and dyslipidemia. However, the relationship between these comorbid conditions and birth weight remains uncertain. We conducted this study to evaluate the relationship between birth weight and cardiovascular risk factors in children and adolescents. Research Methods and Procedures: In a nationwide survey conducted between 1992 and 2000, all schoolchildren 6 to 18 years old with glucosuria, proteinuria, or microscopic hematuria in repeated urine samples were included and received a physical examination and blood test. Those with gestational age 37 weeks were excluded. We enrolled 81,538 children (51,111 girls and 30,427 boys) and obtained their birth weights from the Taiwan Birth Registry. Obesity and hypertension were defined by age- and sex-specific cut-offs. Diabetes was diagnosed if the fasting glucose was 7m M. Results: The risk of obesity was higher for those with birth weights 4000 grams [odds ratio (OR), 1.65] and 3543 to 3999 grams (OR, 1.28) and lower for those with birth weights 2601 to 2999 grams (OR, 0.90), using 3000 to 3542 grams as the reference group. An increased risk of diabetes was associated with both higher and lower birth weights, indicating a U-shaped relationship (OR, 2600 grams, 1.607; 2601 to 2999 grams, 1.119; 3543 to 3999 grams, 1.112; 4000 grams, 1.661). In the 10- to 12-year-old age group, the risk of hypertension was higher in those with birth weights 2600 grams (OR, 1.20). Discussion: Low birth weight was associated with childhood diabetes. High birth weight was correlated with childhood obesity and diabetes. Our data indicate different relationships between birth weight and the development of obesity, hypertension, and diabetes in childhood.

We assessed potential non-response bias in obtaining information on residential extremely low-frequency power frequency magnetic field (MF) in Taiwan. All households occupied by children aged less than 7 years in two study districts, one in an urban town and the other in a rural town, were visited and solicited for on-site measurements in late 2003. The initial response rate was only 32% (33/104, urban) and 60% (61/101, rural). In the same season 1 year later, we performed a second survey of those who declined to be measured at the initial survey and successfully measured another 77 residences (50 and 27 for urban and rural districts, respectively). The two districts were selected mainly because the local public health officers were quite willing to assist the initial survey and to inform residents of the second survey. Except for meteorological conditions, the two surveys came up with very similar findings regarding residential characteristics and power facilities surrounding the houses. The mean residential MF for the urban residences was .121 and .140 micro-Tesla (microT) (P = .620) for the two surveys. The corresponding figures for the rural residences were .119 and .115 microT (P = .802). Although limited in its scope, this study tends to indicate that measurement studies of residential MF are less likely to suffer from serious selection bias if sampling is confined within a small district where people have similar socioeconomic characteristics.

Objective To determine whether the strength of personal coping capability, the sense of coherence (SOC), makes a unique contribution in explaining the extent of depressive symptoms experienced by family caregivers of terminally ill cancer patients. Methods A total of 253 Taiwanese family caregivers of terminally ill cancer patients participated in this survey. Caregiver depressive symptoms were assessed using the CES-D. Potential correlates of depressive symptoms were categorized as: (1) characteristics of the caregivers; (2) demographics and disease-related characteristics of the patients; (3) objective caregiving loads; (4) confidence in end-of-life caregiving; (5) subjective caregiving burden; and (6) SOC. Results Family caregivers scored high on the CES-D [mean (S.D.)=22.24 (11.36)]. Results from the R2 change in the hierarchical multiple regression model indicated that the incremental variance explained by each block of variables for (1) the characteristics of family caregivers, (2) the characteristics of cancer patients, (3) objective caregiving loads, (4) confidence in caregiving, and (5) subjective caregiving burden was 20.5%, 6.8%, 1.5%, 3.7%, and 11.9%, respectively. In the final step of regression, SOC of caregivers increases the explained variation in depressive symptoms by 21.5%. Conclusions This study confirms that, among the independent variables examined in this study, variations in SOC are comparatively important in explaining the variation of depressive symptoms experienced by Taiwanese family caregivers. Developments and evaluations of the effectiveness of clinical interventions aimed at augmenting caregivers' coping capability (such as SOC) to facilitate positive appraisal and finding meaning, to improve understanding of the demands and challenges of caregiving, and to mobilize resources available to manage caregiving tasks are highly recommended.

This study investigated the prevalence, incidence, and hospitalization for chronic airway obstruction (CAO) in a population cohort.Medical reimbursement claims from 1996 to 2002 based on a 1996 insured cohort of 167,372 persons from National Health Insurance, Taiwan, were used. We presented the chronological trends of CAO (International Classification of Diseases, Ninth Revision code 496) and the relationships between the CAO severity and age, sex, urbanization, and hospitalization and comorbidity for the population/= 40 years old.The overall average annual prevalence and incidence rates were 2.48/100 and 0.66/100, respectively, for the population, among 4,568 patients with CAO cared during the study period. For the population aged/= 70 years, the prevalence rates had a peak of 8.83/100 in 1998 and afterward remained a plateau until 2002. The corresponding incidence decreased from 2.48/100 to 1.62/100, and the hospitalization rate for them had a peak of 2.22/100 in 1999. The multivariate logistic regression analysis showed that the risk of hospitalization for CAO was higher for patients with the comorbidity of renal failure, coronary artery disease, and pneumonia and influenza, but lower with skin and joint disorders.The national insurance program promotes patient care and provides a proper pathway for surveillance and identification of CAO.

This study evaluated a directly modulated distributed feedback (DFB) laser diode (LD) for cable TV systems with respect to carrier-to-nonlinear distortion of LDs. The second-order distortion-to-carrier ratio is found to be proportional to that of the second-order coefficient-to-first-order coefficient of the DFB laser diode driving current and to the optical modulation index (OMI). Furthermore, the third-order distortion-to-carrier ratio is proportional to that of the third-order coefficient-to-first-order coefficient of the DFB laser diode driving current, and to the OMI2.

Bone grafting is a commonly used orthopedic surgical procedure that will provide bone formation in bone defects or regions of defective bone healing. A major complication following bone grafting is a postoperative recipient graft site infection that is associated with substantial mortality and increased use of medical resources. The purpose of the study was to identify the risk factors associated with infection after bone-grafting surgery. Data from 1,303,347 patients listed in the Taiwan National Health Insurance Research Database (NHIRD) and admitted to hospitals from 1997 through 2012 who underwent primary bone grafting (mean age: 46.57 years old; mean length of hospital stay: 8.04 days) were analyzed. The incidence of infection by age, hospital stay, gender, income, chronic disease (tuberculosis [TB]; diabetes mellitus [DM]; acquired immunodeficiency syndrome [AIDS]), fracture complications (nonunion; delayed union fracture), types of graft and hospital was evaluated. Three percent of the patients developed a postoperative recipient graft site infection. Multivariable analysis revealed that patients were more likely to develop a post bone-grafting surgery infection if they were older, had a longer hospital stay, were male, had a lower income, or had comorbid TB, DM, or AIDS. Patients were more likely to develop an infection if they had a nonunion, an alloplast graft, or treated in a local clinic. Our findings should provide a clinically relevant reference for surgeons who perform bone grafting. Patients should be informed of the potential risks.

Diabetes has been reported to increase the risk of malignant neoplasms of kidney and bladder, but the studies’ results are still inconclusive. Age, sex, and geographical area-specific incidence and relative risks of above neoplasms are also scarce in the literature. We prospectively investigated the age, sex, geographical area-specific incidence and relative risks of kidney and bladder neoplasms in diabetic population of Taiwan. Diabetic patients (n = 615,532) and age- and sex-matched controls (n = 614,871) were linked to inpatient claims (2000–2008) to identify the admissions for malignant neoplasm of kidney (International Classification of Diagnosis, 9th version, Clinical Modification: 189) and bladder (International Classification of Diagnosis, 9th version, Clinical Modification: 188). The person-year approach with Poisson assumption was used to evaluate the incidence density. We also estimated the age, sex, and geographical area-specific relative risks of above malignancy in relation to diabetes with Cox proportional hazard regression model. The overall incidence density of malignant neoplasm of kidney for diabetic men and women were 3.87 and 4.28 per 10,000 patient-years, respectively; the corresponding figures for malignant neoplasm of bladder were 5.73 and 3.25 per 10,000 patient-years. Compared with the controls, diabetic men were at significantly increased hazards of kidney (covariate adjusted hazard ratio [aHR]: 1.31, 95% confidence interval [CI] 1.18–1.46) and bladder aHR: 1.13, 95% CI 1.04–1.23). Diabetic women, on the contrary, only experienced significantly elevated hazard of kidney neoplasm (aHR: 1.14, 95% CI 1.04–1.26). Diabetic men aged >65 years showed the most significantly increased hazard of developing neoplasm of kidney (aHR: 1.40) and bladder (aHR: 1.13). The most significantly increased hazard of kidney neoplasm was noted for women diabetic patients aged >65 years. There was also a significant interactive effect of geographic area with diabetes on the incidence of kidney and bladder neoplasms in both sexes. Diabetic men >45 years and diabetic women >65 years were found to have significantly increased hazard of malignant neoplasm of kidney, but only diabetic men >65 years were at significantly increased hazard of bladder neoplasm. The significant geographic variations in incidence and relative hazard of kidney and bladder neoplasms warrant further investigations of the underlying reasons.

To compare the incidence and relative risk of falls between adults with and without diabetes, and to prospectively assess the role of history of severe hypoglycemia in the putative relationship between diabetes and falls in younger and older people, respectively. The National Health Insurance Research Database in Taiwan was used in this cohort study. Diabetic cases (with and without history of severe hypoglycemia) and nondiabetic people were followed from 2000 to 2009. There were 31,049 people enrolled in each of the 3 groups. Subdistribution hazard ratio (sHR) of falls was estimated with considering death as a competing risk by using Fine and Gray method. Demographic characteristics, diabetes-related complications, and comorbidities associated with falls were adjusted in multivariable Cox regression model. As compared to nondiabetic people, adjusted sHR was 1.13 for diabetes without history of severe hypoglycemia (DwoH) and 1.63 for diabetes with history of severe hypoglycemia (DwH), respectively. DwH group was associated with a higher risk than DwoH (adjusted sHR = 1.57). All of the excessive risks were more pronounced in people younger than 65 years old than in older people. Patients with diabetes had increased risk of falls. Severe hypoglycemia was further associated with a higher risk in diabetes, the increased hazards were particularly pronounced in people younger than 65 years old. Because falls in younger people may result in a greater economic and social loss, our study call for proper attentions to prevention of falls in younger patients (

A hybrid wireless-over-fiber (WoF) transmission system based on multiple injection-locked Fabry-Perot laser diodes (FP LDs) is proposed and experimentally demonstrated. Unlike the traditional hybrid WoF transmission systems that require multiple distributed feedback (DFB) LDs to support different kinds of services, the proposed system employs multiple injection-locked FP LDs to provide different kinds of applications. Such a hybrid WoF transmission system delivers downstream intensity-modulated 20-GHz microwave (MW)/60-GHz millimeter-wave (MMW)/550-MHz cable television (CATV) signals and upstream phase-remodulated 20-GHz MW signal. Excellent bit error rate (BER), carrier-to-noise ratio (CNR), composite second-order (CSO), and composite triple-beat (CTB) are observed over a 40-km single-mode fiber (SMF) and a 4-m radio frequency (RF) wireless transport. Such a hybrid WoF transmission system has practical applications for fiber-wireless convergence to provide broadband integrated services, including telecommunication, data communication, and CATV services.

The association between dialysis vascular access dysfunction and the risk of developing major adverse cardiovascular events (MACE) in hemodialysis patients is unclear and has not yet been investigated. We analyzed data from the National Health Insurance Research Database of Taiwan to quantify this association. Adopting a case–control design nested within a cohort of patients who received hemodialysis from 2001 to 2010, we identified 9711 incident cases of MACE during the stage of stable maintenance dialysis and 19,422 randomly selected controls matched to cases on age, gender, and duration of dialysis. Events of vascular access dysfunction in the 6-month period before the date of MACE onset (ie, index date) for cases and before index dates for controls were evaluated retrospectively. The presence of vascular access dysfunction was associated with a 1.385-fold higher odds of developing MACE as estimated from the logistic regression analysis. This represents a significantly increased adjusted odds ratio (OR) at 1.268 (95% confidence interval [CI] = 1.186–1.355) after adjustment for comorbidities and calendar years of initiating dialysis. We also noted a significant exposure–response trend (P

Dementia increases the risk of morbidity and mortality in hospitalized patients. However, information on the potential effects of dementia on the risks of acute organ dysfunction, severe sepsis and in-hospital mortality, specifically among inpatients with chronic obstructive pulmonary disease (COPD), is limited. The observational analytic study was inpatient claims during the period from 2000 to 2010 for 1 million people who were randomly selected from all of the beneficiaries of the Taiwan National Health Insurance in 2000. In total, 1406 patients with COPD and dementia were admitted during the study period. Hospitalized patients with COPD and free from a history of dementia were randomly selected and served as control subjects (n = 5334). The patient groups were matched according to age (±3 years), gender, and the year of admission, with a control/dementia ratio of 4. Only the first-time hospitalization data for each subject was analyzed. Logistic regression models were used to calculate the odds ratio (OR) of outcome measures (acute organ dysfunction, severe sepsis, and mortality), controlling for confounding factors (age, sex, comorbidity, infection site, hospital level, and length of stay). In COPD patients with dementia, the incidence rate of severe sepsis and hospital mortality was 17.1% and 4.8%, respectively, which were higher than the controls (10.6% and 2.3%). After controlling for potential confounding factors, dementia was found to significantly increase the odds of severe sepsis and hospital mortality with an adjusted OR (OR) of 1.38 (95% confidence interval [CI] 1.10–1.72) and 1.69 (95% CI 1.18–2.43), respectively. Dementia was also significantly associated with an increased OR of acute respiratory dysfunction (adjusted OR 1.39, 95% CI 1.09–1.77). In hospitalized COPD patients, the presence of dementia may increase the risks of acute respiratory dysfunction, severe sepsis, and hospital mortality, which warrants the attention of health care professionals.

We propose and experimentally demonstrate a hybrid CATV/16-QAM-Digital CATV/16-QAM-OFDM in-building network over a 40-km single-mode fiber and graded index-plastic optical fiber/10-m visible light com- munication. The application of external injection technology with the addition of an optoelectronic feedback that raises the resonance frequency of the laser diode results in increased system transmission capability. Good performances of carrier-to-noise ratio, composite second-order, and composite triple-beat are obtained for the CATV signal. A low bit-error-rate value is achieved for the 16-QAM-Digital CATV/16-QAM-OFDM signal. © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI. (DOI: 10.1117/1.OE.54.3.036108)

The incidence of osteoporotic fracture (OF), a condition that leads to higher morbidity and mortality in the elderly, is increasing yearly worldwide. However, most studies of OF have focused on the epidemiology of initial fractures, mainly in female and white populations. This study aimed to explore the incidence and the risk factors for repeat osteoporotic fracture (ROF) in Taiwan. We performed a retrospective cohort study using the Taiwan National Health Insurance Database (NHIRD) from 1995 through 2011. Individuals aged 65 years or older who experienced an initial OF were included. The patients were followed until death, the end of registration in the NHIRD, ROF occurrence, or the end of the study period (December 31, 2011), whichever occurred first. The incidence of ROF over ≥5 years after the initial fracture was analyzed, and the risk factors for ROF were assessed using Cox proportional hazards models. The incidence rates of ROF were 950.5, 321.4, 158.7, 92.8, and 70.2 per 1000 person-years among subjects in their first, second, third, fourth, and fifth years after the initial OF, respectively. Nearly 45% of the subjects sustained a ROF in the first year after OF. ROF risk increased with age and Charlson Comorbidity Index (CCI) score. Greater risk for ROF was observed among female subjects and those who had suffered from hip and vertebral fracture at the first OF, had undergone OF-related surgery, and had received bone-related medications. The incidence of ROF in the Taiwanese elderly is higher during the first year after the initial OF, and ROF risk increases with age, female sex, high CCI score, and in those who have undergone OF-related surgery, sustained hip or vertebral fracture, and used bone-related medications.

Using the National Health Insurance claim data, we prospectively investigated the age- and sex-specific incidence density and relative hazards of nontraumatic lower-extremity amputation (LEA) and peripheral revascularization procedure (PRP) of the diabetic population in Taiwan.A total of 500,868 diabetic patients and 500,248 age- and sex-matched control subjects, selected from the ambulatory care claim (1997) and the registry for beneficiaries, respectively, were linked to inpatient claims (1997-2002) to identify hospitalizations due to nontraumatic LEA and PRP. Incidence density was calculated under the Poisson assumption, and the Kaplan-Meier analysis was used to assess the cumulative event rates over a 6-year follow-up period. We also evaluated the age- and sex-specific relative hazards of nontraumatic LEA and PRP in relation to diabetes with Cox proportional hazard regression model adjusted for demographics and regional areas.The estimated incidence density of nontraumatic LEA and PRP for diabetic men was 410.3 and 317.0 per 100,000 patient-years, respectively. The corresponding data for diabetic women were relatively low at 115.2 and 86.0 per 100,000 patient-years. Compared with control subjects with the same age and sex, diabetic patients consistently suffered from significantly elevated relative hazards of nontraumatic LEA. Young and female patients were especially vulnerable to experience increased risks of nontraumatic LEA, but such effect modification by age and sex was less apparent for PRP.Multidisciplinary diabetes foot care systems, including the provision of revascularization procedures, should be further enforced to reduce subsequent risks of nontraumatic LEA, especially in young and female diabetic patients.

Summary Objectives This study investigated the chronological trend of low-birth weight in full-term babies (TLBW) in Taiwan in the 1980s and 1990s when the nation experienced a rapid economic advancement, and assessed the association between TLBW and parental education and marital status. Design Data from liveborn singletons from Taiwan's birth registry, born between 1978 and 1997, were used to calculate overall and socio-economic factor-specific rates of TLBW for every 2-year interval in this 20-year period. Methods Logistic regression models were used to assess the trend of TLBW rates, and the interaction between secular time, selected demographic factors and other predictors. Results Among 6,159,070 full-term, liveborn singletons, 208,729 were TLBW. The average annual rate of TLBW was 3.39% in the study period. The period-specific TLBW declined monotonically from 4.41% in 1978–1979 to 2.49% in 1996–1997, representing a 43% deduction. Multiple logistic regression demonstrated persistent declining trends irrespective of the educational level or marital status of the parents. However, the decline was slower for populations of lower socio-economic status, such as less-educated parents and unmarried mothers, which enhanced the inequalities of TLBW risk across populations. The TLBW risk ratios of the least-educated mothers to the most-educated mothers increased from 1.43 in 1978–1979 to 2.05 in 1996–1997. Unmarried status was an independent predictor of elevated risk of TLBW. Conclusions The association between socio-economic inequality and the risk of TLBW infants was sustained over the 1980s and 1990s in Taiwan. Interventions are necessary to promote antenatal care and educational attainment, particularly for lower socio-economic and socially deprived populations in Taiwan.

Mannose-binding lectin (MBL), a member of the innate immune system, initiates complement deposition on microbial surfaces. MBL deficiency is associated with severe respiratory infections. Polymorphisms in the MBL gene (mbl2) were associated with the susceptibility and severity of autoimmune diseases. This study investigated whether mbl2 polymorphisms at positions -550 and -221 and at codon-54 are associated with asthma phenotypes in Chinese children. Asthmatics aged 5-18 yr and non-allergic controls were eligible, and their plasma total and allergen-specific immunoglobulin E (IgE) concentrations were measured by micro-particle immunoassay and fluorescent enzyme immunoassay. mbl2 polymorphisms were genotyped by restriction fragment length polymorphism. Three hundred and seventeen asthmatic children and 140 controls were recruited, with their mean (s.d.) log-transformed plasma total IgE being 2.61 (0.61) and 1.77 (0.77), respectively (p < 0.0001). Polymorphisms at -550 and codon-54 (p < 0.0001 for both) but not at -221 (p = 0.534) of mbl2 were significantly associated with plasma MBL concentrations, mbl2 genotypes were not associated with asthma, atopy, sensitization to individual aeroallergens or spirometric variable. Subjects with LYB haplotype had the lowest plasma MBL concentrations (p < 0.0001), but two- and three-loci mbl2 haplotypes were also not associated with asthma diagnosis. However, patients with LY and LYB haplotypes were less likely to be atopic (p = 0.006 and 0.031). Subjects with LY and LYA were also less likely to be sensitized to cockroach (p = 0.035 and 0.047). The latter three associations became insignificant when adjusted for multiple comparisons. Despite the importance of MBL in innate immunity, our mbl2 polymorphisms only show weak association with asthma and atopy in children.

In this paper, a 32-bit chaos-based pseudo random number generator (PRNG) using timing-based reseeding method with pure digital pseudo noise is proposed for passing the SP 800-22 test. In the iterations of the given chaos equation, when the reseeding timing arrives, the last five least significant bits of the iteration result are masked to produce the pseudo noise, and then the masked result is feedback to the iteration process as a new seed. Using this reseeding method, the proposed PRNG would result in an acceptable quality of randomness without operating in longer bit length digital operation.

This study investigated the influence of petrochemical air pollution on birth weight. Birth data on 92,288 singleton infants with gestational periods of 37–44 wk born in a petrochemical industrial city (Kaohsiung, n = 31,530) with severe pollution or a non-petrochemical industrial city (Taipei, n = 60,758) in Taiwan between 1995 and 1997 were included in this analysis. Air pollutant concentration derived from routinely monitored data showed significantly higher concentrations of SO2, O3, and PM10 in Kaohsiung. Infants with low birth weight (LBW) were significantly more prevalent in Kaohsiung (2.4%) than in Taipei (2.1%). Multivariable logistic regression analysis with adjustment for gestation age, gender, birth order, season of birth, maternal age, and maternal education further suggested that LBW risk in Kaohsiung was 13% higher than that in Taipei (odds ratio [OR] = 1.13, 95%, confidence interval [Cl] = 1.03–1.24).

This survey estimated the extremely-low-frequency magnetic field (ELF-MF) exposure in households with children under the age of 7 years in Taiwan. To select a representative sample, we used the probability proportional to size sampling technique and simple random cluster sampling technique to select study districts in each city/county of Taiwan. A total of 40 districts were selected and all households with children aged less than 7 (n=4184) were visited and solicited for in-home measurements. Four trained interviewers carried out spot-measurements in rooms of each selected household during a two-year period. A questionnaire inquiring residential characteristics and nearby power facilities was also administered to a parent or caregiver. ELF-MF measurements were performed in a total of 2214 households (53% participation rate). Controlling for participation rate, the weighted overall mean magnetic field exposure was estimated at 0.121 (standard deviation 0.185) micro-Tesla (μT) (range 0.010–3.304 μT). Mean exposures were higher than 0.3 and 0.4 μT in an estimated 7.3% (n=159) and 5.4% (n=115) of the households, respectively. There was a substantial agreement between overall mean residential exposure and exposure measured in children's bedrooms. In a multivariate logistic regression model, we noted that buildings with advanced age, buildings for both residential and commercial uses, and buildings close to power facilities were more likely a to have mean exposure above 0.4 μT. Our survey results indicate that residential ELF-MF exposure is likely to be higher for children in Taiwan than for children in Europe and North America. Keywords: Extremely-low-frequency, Magnetic field, Exposure assessment, Measurement, Power lines

Using the National Health Insurance (NHI) claim data, we assessed the effect-modifications by age and sex on the risks of coronary artery disease and revascularization procedures in relation to diabetes in Taiwan. Diabetic patients (n=500,868) and the age-and sex-matched control group (n=500,248) were linked to the inpatient claims (1997-2002) to identify hospitalizations of acute myocardial infarction, ischemic heart disease, coronary revascularization procedures. The effects of age and sex on the risks of such coronary-endpoints were evaluated by Cox proportional hazard regression model adjusted for demographics and regional area. Older ages and being males had absolutely elevated risks of all coronary-related complications, but younger and female diabetic patients had higher relative risks compared to their controls. Effect-modification by age was significant in younger patients especially in subjects35 years for ischemic heart disease (hazard ratio [HR]=11.1; 95% confidence interval [CI]: 7.3-18.1), and coronary revascularization procedures (HR=42.9; 95% CI: 6.0-309.3). Female diabetic patients also had increased HRs of all coronary endpoints particularly for revascularization procedures. In Taiwan, very high relative hazards of coronary complications were observed in younger and female diabetic patients. We must provide an aggressive diabetic care program emphasized to those high-risk groups.

Background Seasonality of suicide has been noted in several studies. A spring peak of suicide was observed, and associations between various climatic parameters and suicide have been suggested. This study sets out to verify seasonal patterns of suicide rates and to explore the association with climate in Taiwan. Method The study used a nationwide mortality database in Taiwan from January 1997 to December 2003. An autoregressive integrated moving average model was applied to examine the presence of seasonality and the association of climate with suicidal death. Results Seasonality with a spring peak was evident in suicidal death regardless of gender or age. Ambient temperature was positively associated with suicide after adjustment for trend and seasonality. Limitations Misclassification and underreporting of suicidal death in the registry system might confound the results. Ecological fallacies might exist. Conclusions The seasonal effect on suicide is significant in Taiwan. Suicide rates may be influenced by ambient temperatures. The findings are of research interest for future studies regarding mechanisms of suicidal behavior, and also of practical interest for better timing of suicide interventions and effective preventive strategies.

The purpose of this study was to determine if elevated ambient exposure to incinerator generated polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) may affect birth outcomes of exposed infants born in Taipei metropolitan areas, Taiwan. The relationships between exposure to elevated PCDD/Fs concentration and various birth outcomes including birth weight, gestational age, and proportion of females were cross-sectionally assessed in 1991 (one year before the incinerator started to operate) and 1997 (five years later), respectively. We used the US EPA Industrial Source Complex Model-Sort Term modeling technique to determine the ambient PCDD/Fs concentrations in the study areas, in which 40 districts with annual averaged PCDD/Fs exposure of ≥0.03 pg TEQ/m3 were considered as the exposed areas and another 40 districts with an estimated concentration of zero were randomly selected as reference areas. Information on birth outcomes was retrieved from the Taiwan's Birth Registry. A total of 6697 and 6282 neonates were included in the analysis for 1991 and 1997, respectively. After controlling for potential confounders, the results showed that the odds ratios (ORs) of low birth weight (0.05 pg TEQ/m3) and 091 (0.03–0.05 pg TEQ/m3) in 1991 and were 1.07 (>0.05 pg TEQ/m3) and 1.06 (0.03–0.05 pg TEQ/m3) in 1997. The corresponding ORs were 1.05/0.86 (1991) and 1.12/1.22 (1997) for preterm (0.03 pg TEQ/m3) and reference group decreased from 3.02 g in 1991 to −5.87 g in 1997. Analysis of continuous data also showed that the mean difference in gestational age between exposed and reference areas decreased from 0.05 weeks in 1991 to −0.09 week (p

Aims and objectives. The aim of this study was to evaluate and compare the self-concept of school-aged children with congenital heart disease to those of normal school-aged children. The primary objective was to analyse results of the Self-Concept Scale questionnaire administered to children with congenital heart disease aged 9–12 years. Sixty-four children with congenital heart disease (study group), and 71 without congenital heart disease (control group), completed the questionnaire. Background. Little attention has focused on school-aged children with congenital heart disease who are in the important stages of developing self-concept. Results. The mean score on the Physical self-concept of the Self-Concept Scale was significantly lower for the study group than the control group (P

Epidemiologic studies suggest increased asthma prevalence in obese subjects. However, the relation between obesity and airway inflammation remains unclear. This cross-sectional study aims to investigate the relation between obesity indices and exhaled nitric oxide (ENO) and leukotriene B(4) (LTB(4)) in children with asthma. Asthmatic patients aged 7-18 yr old were recruited. Weight-for-height Z score was calculated from anthropometry. ENO was measured by online single-breath method using a chemiluminescence analyzer, whereas LTB(4) concentrations in exhaled breath condensate (EBC) were quantified using competitive enzyme immunoassay. Ninety-two asthmatics and 23 controls were recruited. The mean ENO and LTB(4) concentrations in EBC were higher in asthmatic patients (87 p.p.b. and 40.5 pg/ml) than controls (25 p.p.b. and 18.7 pg/ml) (p0.0001 for both). Obesity, as defined by weight120% median weight-for-height, was not associated with any alteration in ENO or LTB(4) concentrations in patients with asthma. Besides, these inflammatory markers did not differ between asthmatics in the highest and lowest quartiles of weight-for-height Z score. On multivariate analysis, ENO showed significant correlation with age (beta = 0.511, p0.0001), peripheral blood eosinophil count (beta = 0.222, p = 0.019), plasma total IgE concentration (beta = 0.187, p = 0.050) and forced expiratory volume in 1-s (FEV(1); beta = -0.221, p = 0.014). None of the factors was associated with LTB(4) concentration in EBC. In conclusion, ENO and LTB(4) concentration in EBC are increased in childhood asthma. However, these inflammatory markers did not differ between obese and non-obese children with asthma.